Clinical ophthalmology (Auckland, N.Z.)最新文献

Purpose: To assess efficacy and safety of brolucizumab versus aflibercept in patients with diabetic macular edema (DME).

Patients and methods: We performed a systematic review and meta-analysis with trial sequential analysis (TSA). We searched Embase, Cochrane Central Register of Controlled Trials and PubMed databases from inception to February 16, 2024 for randomized controlled trials (RCTs) comparing brolucizumab with aflibercept in patients with DME and reporting any of the visual, anatomical and safety outcomes of interest. We conducted a TSA of safety outcomes to assess the risk of statistical errors.

Results: 1253 patients (1253 eyes) from 3 RCTs were included, of whom 57% received brolucizumab and 43% received aflibercept. Mean follow-up ranged from 52 to 100 weeks. Brolucizumab was non-inferior to aflibercept when comparing the mean change of best-corrected visual acuity from baseline (least squares mean difference [LSMD] 0.29; 95% confidence interval [CI] -1.37 to 1.95; p = 0.73). Change in central subfield thickness was significantly greater in the brolucizumab group compared with aflibercept (LSMD -24.5 μm; 95% CI -48.2 to -0.7 μm; p < 0.05). Incidence of adverse events of special interest (AESIs) (risk ratio [RR] 1.7; p = 0.08) and incidence of ≥1 ocular adverse events (AEs) (RR 0.95; p = 0.45) were not significantly different between groups.

Conclusion: Brolucizumab was non-inferior in functional outcomes and was superior to aflibercept in anatomical parameters. Ocular AEs and AESIs were numerically low and not statistically significant. Our findings underscore the importance of new RCTs powered to assess safety outcomes in order to suggest brolucizumab as an alternative to the treatment of DME.

Background: A new, portable computerized distance vision testing (screen plus remote) system called VisionKeys has been developed by the missions equipment developer EyeMobil so we validated it compared to conventional research testing devices.

Methods: Using a standardized protocol of surround HOTV optotype presentation, the VisionKeys was compared to M&S for patched monocular distance visual acuity. A different VisionKeys function with anaglyph spectacle distance stereopsis was compared to near stereo on Titmus circles with Polaroid goggles and PDI Check on an autostereoscopic screen. Raw scores were converted to logarithm and compared with non-parametric and Bland Altman tests.

Results: We recruited 145 ethnically diverse patients with range of acuity -0.4 to 2.6 (NLP) logMAR from a pediatric eye and adult strabismus practice showing median logMAR acuity of 0.0 with VisionKeys significantly finer resolution than 0.1 for M&S (Mann-Whitney z=2.6, p=0.01, n=290). VisionKeys acuity correlated very well with M&S and children under age 7 scored coarser than teens and young adults. Median distance log arc seconds stereo on VisionKeys (2.00) differed from near Titmus circles (1.78) and PDI Check (1.89, Kruskal-Wallis X2(2)=9.8, p=0.007) however they all correlated well by Bland Altman.

Conclusion: The new, portable VisionKeys system gives valid distance visual acuity with slightly finer estimate compared to M&S and the distance stereo compared well with near Titmus and PDI Check. As such, it should be valuable for testing children and adults in remote locations.

Background: The prevalence of vision-threatening diseases, such as age-related macular degeneration (AMD) and diabetic macular edema (DME), is likely to increase in developed countries owing to an aging population, rising life expectancy, and unfavorable lifestyle changes. Increases in the burden of vision-threatening diseases pose a challenge to the healthcare system. After the emergence of intravitreal anti-VEGF inhibitors, treatment options for neovascular AMD (nAMD), DME, retinal vein occlusion (RVO) and myopic choroidal neovascularization (myopic CNV) have increased. As this change in treatment practices has occurred over the last two decades, it is important to demonstrate changes in patient numbers and administered treatments to provide solutions for handling the workload and productivity in ophthalmology departments. In addition, the registry data landscape has evolved in Finland in recent years. Thus, understanding the possibilities and limitations of ophthalmology registries and patient information systems is required.

Methods: This study involved the secondary use of retrospectively registered data from the data warehouse of the Hospital District of Southwest Finland. Our goal was to explore how the workload of ophthalmology departments caused by intravitreal injections has evolved from 2015 to 2022.

Results: The ophthalmology department workload increased significantly during our observation period as the total number of patients receiving intravitreal treatments for nAMD, DME, RVO, and myopic CNV increased 199.6% from 2015 to 2021. In addition, the total number of administered anti-VEGF injections increased during our observation period, but the increase rate began to subside (2019-2020: increase 23.7%, 2020-2021: increase 10.3%, 2021-2022: increase 6.7%).

Conclusion: Supporting the utilization of registry data is essential in evidence-based discussions evolving workload in healthcare. However, it is important to understand the limitations and the quality of the registries. Our study contributes to better understanding the Finnish registry perspective, and it demonstrates the increase in workload in ophthalmology departments caused by intravitreal injections.

Purpose: To assess the outcome of combined phacoemulsification and 360-degree suture trabeculotomy ab externo in chronic angle closure glaucoma using a modified technique.

Methods: This is a retrospective clinical study that included 60 eyes of 60 patients who had undergone combined phacoemulsification and 360-degree suture trabeculotomy ab externo for the treatment of primary chronic angle closure glaucoma. The patients were divided into two groups. The first group (ab externo group) and the second group (modified ab externo group). Data were collected from the records and the final follow-up visit including age, sex, intraocular pressure (IOP), number of antiglaucoma medications, presence of complications, corrected distant visual acuity, and need for another intervention. All the included patients completed at least 12 months follow-up.

Results: The ab externo group included 30 patients and the modified ab externo group included 30 patients. The postoperative IOP was reduced in both groups significantly from the preoperative levels. The percent of reduction was around 60% for both groups (59.5% for the ab externo group and 59.3% for the modified ab externo group). There was statistically significant reduction in the mean amount of required topical medications after the intervention for both groups (p = 0.001). Most of the complications were not serious. Around 90% of the cases in both groups had mild degree of grade 1 hyphema.

Conclusion: Both ab externo 360 degree suture trabeculotomy and its modified technique with ab interno pulling of the suture when combined with phacoemulsification are safe and provide adequate decrease in the intraocular pressure. Modified technique of ab interno pulling of the prolene suture might be more gentle procedure with less severe hyphema and lower chance of rupture of trabeculo-Descemet's membrane.

Purpose: To translate and validate the Adult Strabismus 20 (AS-20) questionnaire, a health-related quality of life questionnaire specifically devised for patients with strabismus.

Methods: The AS-20 was translated in accordance with the principles of good practice for the translation and cultural adaptation process for patient-related outcomes (PRO) according to the methodology recommended by the International Society for Pharmacoeconomics and Outcome Research (ISPOR). The translation, evaluation, and validation were performed in several steps. The study used both qualitative and quantitative methods and engaged 31 final-year orthoptic students in workshops, as well as 19 experts (experienced clinical orthoptists), 17 laymen (members of the public), and 17 patients from national eye clinics. The final translated questionnaire was tested for reliability and validity in 68 adults with strabismus by internal consistency using Cronbach´s alpha and content and construct validity using the Rasch analysis.

Results: The Swedish AS-20 showed a high level of internal consistency. Cronbach´s alpha was 0.95 for the psychosocial subscale and 0.92 for the functional subscale. However, the Rasch analysis indicated that both items and responses should be condensed to achieve content and construct validity.

Conclusion: The thorough translation and evaluation process resulted in a validated AS-20 questionnaire for use in the Swedish language, and shows reliability as an instrument to measure health-related quality of life (HRQoL) in adults with strabismus in a clinical setting.

Background: This study aims to describe the epidemiology and clinical features of patients with intraocular foreign bodies (IOFBs) and analyze the prognostic factors influencing final vision.

Methods: We retrospectively reviewed medical records of patients with IOFBs admitted to Qingdao Eye Hospital of Shandong First Medical University between January 1, 2014, and December 31, 2021. Inclusion criteria involved complete clinical data details of patients diagnosed with intraocular foreign bodies in our hospital who were treated with concurrent surgery and based on IOFB position and characteristics, different surgical methods were employed. The minimum follow-up duration was 6 months. Exclusion criteria were foreign bodies retained in the orbit, organ failure, surgical contraindications, coagulation abnormalities, autoimmune diseases, history of ocular surgery, and ocular space-occupying lesions. Based on IOFB position and characteristics, different surgical methods were employed. Multivariate logistic regression analysis was performed to predict independent factors influencing final visual acuity after IOFBs.

Results: This study analyzed 159 patients (159 eyes) with IOFBs. Based on discharge and follow-up results, IOFB removal was performed through pars plana incision in 105 (67.9%) eyes, corneoscleral limbus incision in 24 (15.1%) eyes, and original wound in 27 (17.0%) eyes. Of these, 44 eyes underwent IOFB removal without vitrectomy, while 55 (34.6%) eyes were treated with silicone oil. Post-vitrectomy, three cases showed secondary macular membrane, five cases exhibited retinal detachment, and enucleation was necessary in three cases. The final best corrected visual acuity (BCVA, logMAR) was 1.06 ±0.88, significantly better than preoperative visual acuity of 1.65 ±0.87 (t = 8.21, p < 0.01). Multi-factor logistic regression analysis revealed that the length of corneal/scleral wound (OR=0.6 P < 0.05), maximum size of IOFB (OR=0.585 P < 0.05), initial presenting VA (OR=0.900 P < 0.05), and macular lesions(OR=0.400 P < 0.05) were risk factors for postoperative vision prognosis after intraocular foreign body surgery.

Conclusion: In a tertiary eye center in northern China, IOFBs predominantly affected the working-age group, particularly males. Factors such as wound length, IOFB size, initial presenting VA, and macular lesions might impact the final visual outcome.

Background: To evaluate the one-year safety and effectiveness of bio-interventional cyclodialysis and scleral reinforcement in open-angle glaucoma (OAG) patients undergoing cataract surgery.

Methods: An ab-interno approach was used to create a sectoral cyclodialysis in OAG patients who were prospectively followed in a consecutive case series. Subsequent visco-cycloplasty with scleral reinforcement using homologous minimally modified allograft scaffold was completed to maintain patency of the cyclodialysis reservoir and increase uveoscleral outflow. Outcomes were mean medicated IOP and mean number of IOP-lowering medications. Safety outcomes were adverse events (AEs) and best-corrected visual acuity (BCVA) changes.

Results: Successful cyclodialysis and allograft bio-scaffold reinforcement was achieved in 117 eyes. There was minimal intraoperatie bleeding and few post-operative adverse events. At baseline, mean BCVA was 0.48 (95% CI: 0.42‒0.54; 20/40 Snellen) and mean ± SD medicated IOP was 20.2 ± 6.0 mmHg on 1.4 ± 1.3 IOP-lowering medications. At 12 months, there was a 27.1% reduction from baseline mean medicated IOP. In eyes with medicated baseline IOP > 21 mmHg (n = 45), there was a 39.7% paired IOP reduction at 12 months with a concurrent reduction in the mean number of IOP lowering medications to 0.8 ± 0.9 which were statistically significant (p < 0.01). For all eyes, 81.9% achieved a medicated IOP ≤ 18 mmHg with no increase in medications at 12 months. To achieve target IOP control, secondary glaucoma surgery was performed in 3.2% of the cases.

Conclusion: IOP lowering through uveoscleral outflow enhancement can be achieved by means of a bio-interventional cyclodialysis procedure with allograft scleral reinforcement.

Purpose: This study was designed to determine the frequency of neurotrophic keratopathy (NK) among patients presenting for cataract surgery consultation in a suburban US practice.

Methods: Patients presenting for cataract consultation were evaluated with corneal staining without anesthetic. Those with grade 1 or greater corneal stain and a tear breakup time (TBUT) of ≤10 underwent corneal sensitivity testing with a Cochet Bonnet esthesiometer. The study also evaluated patient SPEED score symptoms, corrected distance visual acuity (CDVA), corneal higher-order aberrations (HOAs), and conjunctival hyperemia.

Results: Among the 31 patients enrolled, mean corneal esthesiometry was 40 ± 9.5 mm (range 13 to 55). Esthesiometry of ≤40 mm, indicating neurotrophic keratopathy, was detected in 18 (58%, 95% CI 39-75%) patients. Corneal higher-order aberrations were significantly worse at 0.83 ± 0.22 µ in the group with NK vs 0.67 ± 0.16 among patients without NK (P < 0.028). A nonsignificant correlation was found between reduced corneal sensitivity and reduced symptoms. Older patients had slightly reduced sensation, but this trend was not statistically significant. No trend was seen between reduced sensation and either CDVA or corneal staining.

Conclusion: More than half of patients presenting for cataract evaluation with dry eye had stage 1 neurotrophic keratopathy. These patients had significantly worse higher-order aberrations than patients with normal sensitivity. Among patients with NK, symptoms were milder and age was higher, but neither trend was statistically significant. No trend was observed between corneal sensation and either corneal staining or CDVA.

Background: The rise of large language models (LLM) promises to widely impact healthcare providers and patients alike. As these tools reflect the biases of currently available data on the internet, there is a risk that increasing LLM use will proliferate these biases and affect information quality. This study aims to characterize the effects of different race, ethnicity, and gender modifiers in question prompts presented to three large language models (LLM) on the length and readability of patient education materials about myopia.

Methods: ChatGPT, Gemini, and Copilot were provided a standardized prompt incorporating demographic modifiers to inquire about myopia. The races and ethnicities evaluated were Asian, Black, Hispanic, Native American, and White. Gender was limited to male or female. The prompt was inserted five times into new chat windows. Responses were analyzed for readability by word count, Simple Measure of Gobbledygook (SMOG) index, Flesch-Kincaid Grade Level, and Flesch Reading Ease score. Significant differences were analyzed using two-way ANOVA on SPSS.

Results: A total of 150 responses were analyzed. There were no differences in SMOG index, Flesch-Kincaid Grade Level, or Flesch Reading Ease scores between responses generated with prompts containing different gender, race, or ethnicity modifiers using ChatGPT or Copilot. Gemini-generated responses differed significantly in their SMOG Index, Flesch-Kincaid Grade Level, and Flesch Reading Ease based on the race mentioned in the prompt (p<0.05).

Conclusion: Patient demographic information impacts the reading level of educational material generated by Gemini but not by ChatGPT or Copilot. As patients use LLMs to understand ophthalmologic diagnoses like myopia, clinicians and users should be aware of demographic influences on readability. Patient gender, race, and ethnicity may be overlooked variables affecting the readability of LLM-generated education materials, which can impact patient care. Future research could focus on the accuracy of generated information to identify potential risks of misinformation.

Aim: The main indications for Ahmed glaucoma valve (AGV) include neovascular glaucoma, congenital glaucoma, primary open angle glaucoma and patients with failed previous trabeculectomy. This article aims to investigate the complications of AGV in Jordanian glaucoma patients and to justify the main risk factors.

Methods: Retrospectively, we report 87 eyes of 83 patients who underwent AGV implantation for different indications. The database included demographic data, past ocular and medical history, the indication for surgery, the perioperative outcome parameters at different follow-up visits, and the developed complications at each post-operative visit.

Results: More than half of the patients (54%) were males. The mean age of the patients was 47.4 years. Neovascular glaucoma was the most common indication for AGV implantation. Valve encapsulation was the most encountered complication. About one quarter of the eyes at one time underwent valve revision. Younger patients, neovascular glaucoma and congenital glaucoma were associated significantly with AGV failure and for the need for revision surgery.

Conclusion: AGV is the predominant glaucoma surgery performed in Jordan. Valve encapsulation is the most common complication for AGV implant in Jordanian patients which may be related to racial and genetic factors. Neovascular glaucoma has a high burden in Jordan and secondary causes should be controlled adequately.